Local health department activities have changed over time: Are we reducing disparities in mortality as we change course?

Differences in morbidity and mortality rates between Black and White residents are often perceived to be a strong measure of the adequacy of equitable services and primary prevention strategies available in a community. The sets of activities that local public health agencies (LPHAs) choose to conduct has varied over time, however, little is known about how these historical trends in public health activity at the local level have impacted the health of communities and racial/ethnic disparities. The cross sectional and time series research to be presented here will describe relationships between LPHA activities, expenditures, and Black-White mortality over time. County-level Profile Survey data from the National Association of City and County Health Officials (NACCHO) from throughout the 1990's were merged with data for county characteristics from the US Census and the Area Resource File, and county mortality data from CDC Wonder/National Center for Health Statistics. We examined whether the level of service in LPHA activity domains, such as surveillance and epidemiology, environmental health, immunizations, and community health assessment and planning, are associated with local LPHA expenditures and local changes in mortality disparities. Bivariate and regression results of these analyses will be presented, providing lessons learned from our recent history of administrative changes in programs and expenses in LPHAs, as well as policy implications for developing strategies to improve population health and reduce disparities.